When does a patient on RVD (Lenalidomide, VELCADE (Bortezomib), Dexamethasone) plus Darzalex (Daratumumab) take 20mg of dexamethasone at home?

Dexamethasone Home Dosing in RVD Plus Daratumumab

Patients on RVD plus Daratumumab take 20 mg dexamethasone at home on the day AFTER each bortezomib dose (days 2,5,9, and 12 during cycles 1-8), because the 20 mg dose on the actual day of bortezomib is administered at the clinic as a pre-infusion medication before daratumumab. 1

Dosing Schedule Breakdown

During Cycles 1-8 (21-day cycles):

• At the clinic: Dexamethasone 20 mg is given on days 1,4,8, and 11 (the days of bortezomib administration) as part of the pre-infusion protocol before daratumumab 1
• At home: Patients take dexamethasone 20 mg orally on days 2,5,9, and 12 (the day after each bortezomib dose) 2, 1
• This creates the pattern: dexamethasone 20 mg on days 1,2,4,5,8,9,11, and 12 1

After Cycle 8:

• Bortezomib dosing changes to days 1 and 8 only in subsequent cycles 2
• The home dexamethasone doses would correspondingly be on days 2 and 9 2

Key Clinical Considerations

Why This Split Dosing Pattern:

• The European Society for Medical Oncology recommends dexamethasone 20 mg on the day of and day after bortezomib for VRd regimens 2, 3
• When daratumumab is added, the "day of" dose becomes part of the mandatory pre-infusion medication protocol at the infusion center 1
• This maintains the same total dexamethasone exposure (40 mg per bortezomib dose) while incorporating daratumumab's pre-medication requirements 1

Common Pitfall to Avoid:

• Do not have patients take an additional 20 mg at home on the same day as their clinic visit - this would result in 60 mg total dexamethasone that day (40 mg at clinic plus 20 mg at home), which exceeds the intended dose 1
• The home dose is specifically for the "off" day following each bortezomib administration 1

Practical Administration Tips:

• Patients should clearly understand they take dexamethasone at home only on days 2,5,9, and 12 during the first 8 cycles 1
• These are the days immediately following their clinic visits for bortezomib/daratumumab infusions 1
• The clinic-administered dose on the day of bortezomib counts as their "day of" dexamethasone 1